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5. Sports Medicine MCQs

Practice Set 174 of 360

This practice set contains high-yield board review questions covering key concepts in 5. Sports Medicine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 3461

Topic: 5. Sports Medicine

A 65-year-old woman suffers an acute patellar tendon rupture 3 months following a primary TKA. Primary repair is attempted but fails at 6 weeks postoperatively. She now has an active extensor lag of 40 degrees and profound difficulty mobilizing. What is the most reliable surgical option for restoring extensor mechanism function?

. Revision primary repair augmented with heavy non-absorbable sutures
. Autologous semitendinosus and gracilis tendon reconstruction
. Achilles tendon allograft reconstruction with a calcaneal bone block
. Medial gastrocnemius rotational flap coverage
. Tibial tubercle osteotomy and proximal advancement

Correct Answer & Explanation

. Achilles tendon allograft reconstruction with a calcaneal bone block

Explanation

In the setting of a failed extensor mechanism repair after TKA, direct primary repair has an unacceptably high failure rate. Use of an extensor mechanism allograft (such as an Achilles tendon with a bone block or a whole patellar-tendon-tubercle allograft) or synthetic mesh offers the most reliable reconstruction.

Question 3462

Topic: 5. Sports Medicine

A 78-year-old woman presents with an inability to actively extend her knee 3 years following a primary total knee arthroplasty. Examination confirms a palpable gap over the patellar tendon. What is the most reliable surgical reconstruction method for this chronic disruption?

. Primary end-to-end repair with heavy non-absorbable sutures
. Hamstring autograft reconstruction
. Gastrocnemius rotational flap
. Synthetic mesh (e.g., Marlex) reconstruction or extensor mechanism allograft
. Patellectomy with V-Y quadricepsplasty

Correct Answer & Explanation

. Synthetic mesh (e.g., Marlex) reconstruction or extensor mechanism allograft

Explanation

Chronic patellar tendon ruptures in the setting of TKA respond poorly to primary repair. Reconstruction with a synthetic mesh or a full extensor mechanism allograft offers the most reliable restoration of active extension.

Question 3463

Topic: 5. Sports Medicine

A 72-year-old woman presents with the inability to actively extend her knee 3 years after a total knee arthroplasty. Imaging confirms a complete patellar tendon rupture. What is the most reliable surgical management for this chronic rupture?

. Primary repair with heavy nonabsorbable suture
. Primary repair with semitendinosus autograft augmentation
. Extensor mechanism allograft reconstruction
. Gastrocnemius rotational flap
. Hamstring autograft reconstruction

Correct Answer & Explanation

. Extensor mechanism allograft reconstruction

Explanation

Primary repair of chronic patellar tendon ruptures post-TKA has an unacceptably high failure rate. Extensor mechanism allograft or synthetic mesh reconstruction provides the most reliable long-term outcomes in this setting.

Question 3464

Topic: Knee Sports

The anterior cruciate ligament (ACL) receives its primary blood supply from which of the following vascular structures?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery, a branch of the popliteal artery, pierces the posterior capsule to provide the primary blood supply to the cruciate ligaments via the synovial fold.

Question 3465

Topic: Knee Sports

The primary vascular supply to the anterior cruciate ligament (ACL) is derived from which of the following arteries?

. Lateral inferior genicular artery
. Medial inferior genicular artery
. Middle genicular artery
. Descending genicular artery
. Anterior tibial recurrent artery

Correct Answer & Explanation

. Middle genicular artery

Explanation

The middle genicular artery originates from the popliteal artery, pierces the posterior capsule, and provides the primary vascular supply to the central pivot structures of the knee, including the ACL and PCL.

Question 3466

Topic: 5. Sports Medicine
A 22-year-old athlete sustains a high-energy knee dislocation (KD-III). The knee is successfully reduced in the emergency department. Pulses are symmetric with the uninjured limb, and the Ankle-Brachial Index (ABI) is 0.85. What is the most appropriate next step in management?
. Serial neurovascular checks every 2 hours
. Duplex ultrasonography
. CT angiography of the lower extremity
. Immediate surgical exploration of the popliteal artery
. Discharge with a rigid knee immobilizer and close follow-up

Correct Answer & Explanation

. CT angiography of the lower extremity

Explanation

An ABI less than 0.9 in the setting of a knee dislocation is highly suggestive of an occult vascular injury. CT angiography is strictly indicated to evaluate for a popliteal artery intimal tear or occlusion.

Question 3467

Topic: Shoulder & Hip Sports

A 65-year-old woman sustains a first-time traumatic anterior shoulder dislocation. After successful closed reduction, she continues to have profound weakness in active shoulder abduction and external rotation. The most likely cause is:

. Axillary nerve neurapraxia
. Brachial plexus injury
. Rotator cuff tear
. Recurrent dislocation
. Deltoid muscle rupture

Correct Answer & Explanation

. Rotator cuff tear

Explanation

In patients older than 40 years, an anterior shoulder dislocation is highly associated with massive rotator cuff tears. Persistent weakness in abduction and external rotation post-reduction warrants an MRI to evaluate for a cuff tear.

Question 3468

Topic: Shoulder & Hip Sports

A 35-year-old man presents with a locked posterior shoulder dislocation following a seizure. CT scan reveals an anteromedial humeral head defect (reverse Hill-Sachs lesion) involving 35% of the articular surface. Which of the following is the most appropriate surgical management?

. Closed reduction and spica casting
. Open reduction and anterior Bankart repair
. Arthroscopic Latarjet procedure
. Transfer of the lesser tuberosity into the defect
. Total shoulder arthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect

Explanation

For locked posterior shoulder dislocations with an articular defect between 20% and 40%, a modified McLaughlin procedure (transferring the lesser tuberosity into the defect) is indicated. This restores rotational stability and prevents the defect from engaging the posterior glenoid rim.

Question 3469

Topic: Shoulder & Hip Sports

A 24-year-old sustains an anterior shoulder dislocation. Closed reduction in the emergency department is unsuccessful despite adequate procedural sedation and muscle relaxation. Which structure is most likely interposing and preventing closed reduction?

. Long head of the biceps tendon
. Glenoid labrum
. Infraspinatus tendon
. Middle glenohumeral ligament
. Coracohumeral ligament

Correct Answer & Explanation

. Long head of the biceps tendon

Explanation

Irreducible anterior shoulder dislocations are relatively rare and are most commonly caused by interposition of the long head of the biceps tendon, the subscapularis tendon, or fracture fragments. Open reduction is required to clear the interposed tissue.

Question 3470

Topic: Shoulder & Hip Sports

Following a traumatic anterior shoulder dislocation, a patient is unable to actively abduct the arm and has decreased sensation over the lateral aspect of the shoulder. Due to the most likely nerve injury, which of the following muscles will also exhibit weakness?

. Supraspinatus
. Teres major
. Teres minor
. Subscapularis
. Infraspinatus

Correct Answer & Explanation

. Teres minor

Explanation

The axillary nerve is frequently injured during anterior shoulder dislocations. It innervates both the deltoid and the teres minor muscles and provides sensation to the lateral shoulder (superior lateral cutaneous nerve of the arm).

Question 3471

Topic: Shoulder & Hip Sports

A 55-year-old active woman sustains an anterior shoulder dislocation with an associated displaced greater tuberosity fracture. After successful closed reduction of the glenohumeral joint, radiographs show the greater tuberosity remains displaced 10 mm superiorly. What is the recommended treatment?

. Sling immobilization for 4 weeks
. Open reduction and internal fixation of the tuberosity
. Arthroscopic Bankart repair only
. Total shoulder arthroplasty
. Hemiarthroplasty

Correct Answer & Explanation

. Open reduction and internal fixation of the tuberosity

Explanation

Greater tuberosity fractures that remain displaced by more than 5 mm (and frequently >3 mm in active patients) after shoulder reduction require surgical fixation. Left untreated, they cause significant subacromial impingement and functional rotator cuff deficits.

Question 3472

Topic: Shoulder & Hip Sports

During arthroscopy for recurrent anterior shoulder instability, a lesion is noted where the anteroinferior labrum is avulsed but displaced medially along the glenoid neck with an intact periosteal sleeve. This pathoanatomic lesion is best described as an:

. Classic Bankart lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion
. SLAP tear

Correct Answer & Explanation

. ALPSA lesion

Explanation

An Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesion involves the anteroinferior labrum tearing and displacing medially. Unlike a classic Bankart lesion, the anterior periosteum remains intact, creating a sleeve that strips down the glenoid neck.

Question 3473

Topic: 5. Sports Medicine

A 22-year-old athlete sustains a traumatic anterior shoulder dislocation. Following closed reduction in the emergency department, he reports numbness over the lateral aspect of his shoulder. Which muscle's function is most likely to be impaired due to the associated nerve injury?

. Biceps brachii
. Teres major
. Deltoid
. Supraspinatus
. Triceps brachii

Correct Answer & Explanation

. Deltoid

Explanation

Numbness over the lateral shoulder (regimental badge area) indicates axillary nerve neuropraxia, the most common nerve injury in anterior shoulder dislocations. The axillary nerve innervates the deltoid and teres minor muscles.

Question 3474

Topic: Shoulder & Hip Sports

A 19-year-old college football player experiences recurrent anterior shoulder instability. An MRI arthrogram reveals an impaction fracture on the posterolateral aspect of the humeral head. What is the proper eponym for this osseous defect?

. Bankart lesion
. Hill-Sachs lesion
. ALPSA lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Hill-Sachs lesion

Explanation

A Hill-Sachs lesion is a posterolateral humeral head impaction fracture caused by the humeral head striking the anterior glenoid rim during an anterior shoulder dislocation. A Bankart lesion refers to the anterior inferior glenoid labral tear.

Question 3475

Topic: Shoulder & Hip Sports

A 22-year-old rugby player presents with recurrent anterior shoulder instability. A CT scan with 3D reconstruction reveals a glenoid bone loss of 28%. Which of the following is the most appropriate surgical treatment?

. Arthroscopic Bankart repair
. Open capsular shift
. Coracoid transfer (Latarjet procedure)
. Remplissage procedure alone
. Putti-Platt procedure

Correct Answer & Explanation

. Coracoid transfer (Latarjet procedure)

Explanation

In patients with significant anterior glenoid bone loss (typically greater than 20-25%), soft tissue stabilization alone has an unacceptably high failure rate. The Latarjet procedure, involving coracoid transfer to the anterior glenoid, restores the bony arc and provides a dynamic sling effect.

Question 3476

Topic: Shoulder & Hip Sports

A 45-year-old man presents with severe shoulder pain and an inability to externally rotate his arm following a generalized tonic-clonic seizure. Radiographs demonstrate a posterior shoulder dislocation with a reverse Hill-Sachs lesion involving 25% of the articular surface. Which of the following is the most appropriate surgical management?

. Closed reduction and immobilization in internal rotation
. Arthroscopic posterior Bankart repair
. Transfer of the lesser tuberosity into the defect
. Latarjet procedure
. Hemiarthroplasty

Correct Answer & Explanation

. Transfer of the lesser tuberosity into the defect

Explanation

Posterior shoulder dislocations are frequently accompanied by an anteromedial humeral head impaction fracture (reverse Hill-Sachs lesion). For defects involving 20% to 40% of the articular surface, transfer of the lesser tuberosity into the defect (modified McLaughlin procedure) prevents engagement and restores stability.

Question 3477

Topic: 5. Sports Medicine

A 22-year-old athlete presents with his first episode of an anterior shoulder dislocation following a rugby tackle. After closed reduction, what is the single most important prognostic factor for recurrent instability?

. Mechanism of injury
. Position of immobilization (internal vs. external rotation)
. Age of the patient at the time of injury
. Presence of an osseous Bankart lesion on initial radiograph
. Duration of initial immobilization

Correct Answer & Explanation

. Age of the patient at the time of injury

Explanation

The age of the patient at the time of the initial dislocation is the most significant prognostic factor for recurrence. Patients under 20 years old have recurrence rates exceeding 80%, whereas those over 40 have recurrence rates less than 15%.

Question 3478

Topic: Shoulder & Hip Sports

A 45-year-old man presents with severe shoulder pain following a generalized tonic-clonic seizure. Examination shows the arm is locked in internal rotation. Radiographs confirm a posterior shoulder dislocation with a 45% anteromedial humeral head impression defect (reverse Hill-Sachs lesion). What is the most appropriate surgical management?

. Closed reduction and sling immobilization
. Arthroscopic posterior Bankart repair
. Open reduction and subscapularis transfer (McLaughlin procedure)
. Open reduction and lesser tuberosity transfer (Modified McLaughlin)
. Hemiarthroplasty or total shoulder arthroplasty

Correct Answer & Explanation

. Hemiarthroplasty or total shoulder arthroplasty

Explanation

For posterior shoulder dislocations with an articular defect (reverse Hill-Sachs) larger than 40-45%, the joint is generally considered non-reconstructible with tendon or tuberosity transfers. Arthroplasty (hemiarthroplasty or total shoulder arthroplasty) is the indicated treatment.

Question 3479

Topic: Shoulder & Hip Sports

A 65-year-old male presents with severe right shoulder pain after experiencing a grand mal seizure. Radiographs reveal a posterior shoulder dislocation on the axillary view. What associated bony defect is most likely present on the anteromedial aspect of the humeral head?

. Hill-Sachs lesion
. Reverse Hill-Sachs lesion
. Bankart lesion
. Bony Bankart lesion
. Greater tuberosity fracture

Correct Answer & Explanation

. Reverse Hill-Sachs lesion

Explanation

Posterior shoulder dislocations, frequently caused by seizures or electrocution due to violent internal rotator muscle contraction, are commonly associated with an impaction fracture on the anteromedial aspect of the humeral head. This specific defect is known as a reverse Hill-Sachs lesion.

Question 3480

Topic: 5. Sports Medicine

A 60-year-old woman is scheduled for an L4-L5 posterior lumbar interbody fusion (PLIF) with pedicle screw instrumentation. Which of the following intraoperative technical errors is most significantly linked to the accelerated development of adjacent segment disease at the L3-L4 level?

. Placement of the interbody cage in the anterior third of the disc space
. Violation of the L3-L4 superior facet joint capsule during L4 pedicle screw placement
. Excessive decortication of the L4 and L5 transverse processes
. Use of local laminectomy bone graft rather than iliac crest autograft
. Preservation of the supraspinous ligament between L3 and L4

Correct Answer & Explanation

. Violation of the L3-L4 superior facet joint capsule during L4 pedicle screw placement

Explanation

Violation of the adjacent, unfused superior facet joint (L3-L4) during pedicle screw insertion at the uppermost instrumented vertebra (L4) destroys the integrity of the facet complex, drastically accelerating adjacent segment degeneration.

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